To Health Insurance Consumers:

QUESTIONS TO ASK YOUR HMO

based on

"THE  TEN COMMANDMENTS for HMOs"

Prepared by:  Elizabeth Charlton Moore
email: lizmoore@healthcare-disclose.com

 

1.  Cost Containment & Physician Incentives.

 

2.  Physician Credentials.

 

3.  Medical Necessity.

 

4.  Appeal Procedures.

 

5.  Choice of Physicians.

 

6.  Revenue Breakdown.

      What percentage of your HMO revenue goes for:

 

7.  Prescription Drugs.

Most HMOs have formularies, which are lists of the prescription drugs approved for use by their physicians.  Physicians are often pressured to prescribe only the drugs on the formulary, and in some cases pharmacies are given bonuses to switch a prescription to the cheapest drug available.

 

8.  Access to Specialists.

 

9.  Patient Satisfaction.

 

10.  Emergency Care.


If you're thinking of joining an HMO, or of changing from one HMO to another, send out "The TEN COMMANDMENTS for HMOs", plus the above "Questions to Ask Your HMO".  Ask the HMO to respond with answers. If they don't answer, or if you don't like the answers, DON'T JOIN that HMO. Do the same with another HMO until you find one that answers your consumer concerns.

PLEASE COPY the "Questions to Ask Your HMO" and  "The TEN COMMANDMENTS for HMOs" and DISTRIBUTE FREELY. When more people ask good questions and insist on answers, we'll have better consumer protection for everybody.